Is a too low plasminogen level in the plasma of kidney transplant recipients the reason of irreversable rejection reactions?

Objective: Introduction: A functioning fibrinolytic system is the prerequisite for the patency of blood vessels.For this, the balance between the central protein of the fibrinolytic system, Plasminogen(Plg) and the main Plasmin inhibitor Alpha2-Antiplasmin(APL) has to be warranted. Under certain circumstances (e.g. severe septicaemia) the APL level of the patients plasma exceeds the Plg level markedly leading to persistent clots in the capillaries and thus to organ failure (e.g.the kidney).In a prior study we could show that by substitution of Glu-Plasminogen to balance the APL-Level, the organ failure could be reversed and the patients survived.
Aim: A similar situation as in septicaemia can also be expected in severe rejection reactions after organ transplantation, which resemble inflammation reactions. We therefore now investigated the levels of APL, Plg and other plasma parameters at rejection reactions after kidney transplantations.

Methods: Methods: The plasma parameters were determined by immunological methods.We report the data of 20 kidney transplantations. As control group served 41 patients with chronic renal diseases.

Results: Results: The patients were assigned to three groups. Group A: patients with only moderate rejection reactions and successful graft survival (7 cases). Group B: patients with severe rejection reactions leading to graft removal (13 cases). Group C: control group (41 cases).
Table: Concentrations and Ratios of APL and Plg
Group Plg (% of norm) APL (% of norm) APL/Plg
A 93,7 109,3 1,17
B 76,5 115,2 1,51
C 88,2 92,3 1,05

Conclusion: Conclusion: The results show that in patients with severe rejection reactions (group B) the level of APL exceeds markedly the level of Plg; thus,the reactive fibrinolysis is impaired and thrombus formation in the blood vessels o the grafts occurs and persists, leading finally to the loss of the graft.
When clinically applicable Glu-plasminogen concentrate would become again available,it should be tested, if its substitution to balance the level of APL could save the grafts.